Research has shown that the risk of complications in surgery is directly related to the surgeon's experience. Since adrenal surgery is relatively uncommon, it is critical to find a surgeon who specializes in this type of operation. In experienced hands, the risks of adrenal surgery, especially laparoscopic adrenalectomy, are low.
As with any operation, there is a risk of infection and bleeding. Wound infections (i.e. an infection in the skin at the incision site) and abscess (i.e. an infection on the inside) occur in about 1 to 2% of cases but are more likely in open operations. Infections are more common in patients with Cushing's Syndrome because this disease causes poor wound healing. Similarly, although the adrenal gland sits next to some of the biggest blood vessels in the body, significant bleeding and the need for blood transfusion are rare and happen in less than 1% of cases. This is also more likely to happen during open operations and in patients who have pheochromocytoma/paraganglioma and very large tumors. Another potential problem from any type of surgery is blood clot formation (i.e. DVT or deep venous thrombosis). These blood clots can break off and travel to the lungs (i.e. PE or pulmonary embolus). In order to prevent blood clots, sequential compression devices (i.e. Venodynes) are placed on the legs before, during, and after surgery to maintain the circulation. In addition, an injection of a mild blood thinner may be given. Fortunately, DVT and PE are very rare. Lung infections (i.e. pneumonia) are rare in patients who have had laparoscopic adrenalectomy, but can happen in up to 6% of patients after open adrenalectomy. Any surgery in the abdomen may cause the intestines to "fall asleep" for a brief period of time after the operation called an ileus. The ileus happens in less than 3% of patients and usually is better with a few days to a week of the operation. Ileus is more common after open adrenalectomy. Finally, the risk of stroke, heart attack, and other major problems are extremely rare and depends mostly on the patient's overall health and other medical issues. Patients should have a pre-operative evaluation to help determine these risks and potential ways to avoid them.
Adrenal insufficiency is a life-threatening problem where the body is not making enough steroids. Patients whose other adrenal gland is normal should not develop adrenal insufficiency. In fact, a person needs only about 33% of their total adrenal volume to be normal from a hormone standpoint. Therefore, removing only one adrenal gland should leave patients with more than enough adrenal tissue. Adrenal insufficiency usually only happens in patients with Cushing's Syndrome where the other adrenal gland is temporarily "asleep" because the tumor has suppressed it or in patients who have both adrenal glands removed who are not getting enough steroid replacement in pill form. Symptoms of this condition include feeling generally unwell, nausea, vomiting and confusion. Patients may also become depressed and their doctors should be notified right away if friends, family, or co-workers notice a change in the patient's behavior. Patients who have had an adrenalectomy for Cushing's may need steroid medication for a year or more following surgery. Patients who have had both adrenals removed, will require lifelong steroids.
Injury to surrounding organs
The adrenal glands are surrounded by a number of organs and large blood vessels that may very rarely be injured as they are moved aside (i.e. mobilized) during the operation. The left adrenal gland is surrounded by the spleen, pancreas, stomach, kidney, colon, and their blood vessels. Although it is rare to damage one of these organs (i.e. less than 1%), the spleen is the most commonly injured and may sometimes need to be removed. The right adrenal gland is surrounded by the liver, duodenum (i.e. 1st part of the small intestine), colon, pancreas, kidney, and inferior vena cava (i.e. IVC — the largest vein in the body that takes blood from the lower half of the body back to the heart). An injury to the blood vessels of the kidney may result in hypertension (high blood pressure). For large tumors and adrenocortical cancers, the kidney may need to be removed with the adrenal gland if there is a chance that the tumor is growing into it (i.e. invasion).